CAJ | 학술논문

目的：了解深圳市龙华新区和光明新区三家三级区属医院铜绿假单胞菌感染分布及耐药性，为科学用药提供依据。方法收集2013年6月至2014年11月三家三级区属医院各科住院临床标本共3176份，采用VITEK-32细菌鉴定仪进行细菌鉴定，药敏试验采用K-B法和微量肉汤稀释法(MIC法)，并对结果进行统计分析。结果3176份标本中铜绿假单胞菌总分离率为51.16%(1625/3176)，其中痰液标本为52.8%(858/1625)，其次为支气管肺泡灌洗液和脓液，分别为20.1%(327/1625)和16.7%(271/1625)；ICU、神经外科和心胸外科铜绿假单胞菌分离率分别为41.6%(676/1625)、15.9%(259/1625)和19.1%(310/1625)；碳青霉烯类敏感、耐碳青霉烯类及泛耐药铜绿假单胞菌分离率分别为67.1%(1090/1625)、31.6%(514/1625)和1.29%(21/1625)；耐碳青霉烯类铜绿假单胞菌对临床常用的15种抗菌药除了多黏菌素B外均比碳青霉烯类敏感的要严重，耐药率之间差异有统计学意义(χ2=12.617~80.654，P<0.05)，2例耐碳青霉烯类铜绿假单胞菌对多黏菌素B出现耐药，除对阿米卡星、庆大霉素、妥布霉素有较高的敏感性外，其余11种抗菌药物的耐药率均>60%以上。结论铜绿假单胞菌分离率较高，主要来自呼吸道标本和ICU病区；耐碳青霉烯类铜绿假单胞菌耐药性比碳青霉烯敏感的要严重，应采取有效的预防及合理使用抗菌药措施，杜绝耐碳青霉烯类和泛耐药铜绿假单胞菌的蔓延。
목적：료해심수시룡화신구화광명신구삼가삼급구속의원동록가단포균감염분포급내약성，위과학용약제공의거。방법수집2013년6월지2014년11월삼가삼급구속의원각과주원림상표본공3176빈，채용VITEK-32세균감정의진행세균감정，약민시험채용K-B법화미량육탕희석법(MIC법)，병대결과진행통계분석。결과3176빈표본중동록가단포균총분리솔위51.16%(1625/3176)，기중담액표본위52.8%(858/1625)，기차위지기관폐포관세액화농액，분별위20.1%(327/1625)화16.7%(271/1625)；ICU、신경외과화심흉외과동록가단포균분리솔분별위41.6%(676/1625)、15.9%(259/1625)화19.1%(310/1625)；탄청매희류민감、내탄청매희류급범내약동록가단포균분리솔분별위67.1%(1090/1625)、31.6%(514/1625)화1.29%(21/1625)；내탄청매희류동록가단포균대림상상용적15충항균약제료다점균소B외균비탄청매희류민감적요엄중，내약솔지간차이유통계학의의(χ2=12.617~80.654，P<0.05)，2례내탄청매희류동록가단포균대다점균소B출현내약，제대아미잡성、경대매소、타포매소유교고적민감성외，기여11충항균약물적내약솔균>60%이상。결론동록가단포균분리솔교고，주요래자호흡도표본화ICU병구；내탄청매희류동록가단포균내약성비탄청매희민감적요엄중，응채취유효적예방급합리사용항균약조시，두절내탄청매희류화범내약동록가단포균적만연。
Objective To investigate the distribution of Pseudomonas aeruginosa infection and drug resis-tance in three hospitals in Longhua New District and Guangming New District of Shenzhen in order to provide the ba-sis for scientific and medical treatment. Methods A total of 3 176 clinical specimens were collected from June 2013 to November 2014 in the three hospitals. VITEK-32 bacteria identification analyzer system was used for bacteria iden-tification. K-B method and broth dilution method (minimum inhibitory concentration, MIC) were applied for drug sen-sitive test. Results Among the 3 176 specimens, 1 625 strains of Pseudomonas aeruginosa were separated, and the total separation rate of Pseudomonas aeruginosa was 51.16%(1 625/3 176), including 52.8%(858/1 625) sputum specimens, followed by bronchoalveolar lavage [20.1%(327/1 625)] and pus [16.7%(271/1625)]. The separation rate of Pseudomo-nas aeruginosa isolated from ICU, neurosurgery and thoracic surgeons were 41.6%(676/1 625), 15.9%(259/1 625) and 19.1% (310/1 625), respectively. The Pseudomonas aeruginosa sensitive to carbapenems, resistant to carbapenems, and those with extensive drug resistance isolated accounted for 67.1%(1 090/1 625), 31.6%(514/1 625) and 1.29%(21/1 625), respectively. The Pseudomonas aeruginosa resistant to carbapenems were more sensitive to 15 clinical com-monly used antimicrobials than Pseudomonas aeruginosa sensitive to carbapenems, in addition to polymyxin B, and the differences were statistically significant (χ2=12.617~80.654, P<0.05). Two cases of pseudomonas aeruginosa resistant to carbapenems were found resistant to polymyxin B, and they were highly resistant to the 11 kinds of antimicrobial drugs (>60%) in addition to amikacin, gentamycin, tobramycin. Conclusion The separation rate of Pseudomonas aeruginosa is high, and the strains are mainly isolated from respiratory tract specimens and ICU ward. The drug resistance in carbap-enems-resistant Pseudomonas aeruginosa is more serious than that in carbapenems-sensitive Pseudomonas aeruginosa. Effective measures should be taken for prevention and rational use of antibacterial drugs, and to avoid the spread of car-bapenems-sensitive Pseudomonas aeruginosa and the strains with extensive drug resistance.